Development of a questionnaire to measure quality of life in adolescents with food allergy: the FAQL-teen.

BACKGROUND: Living with food allergies affects quality of life (QOL) and may be particularly problematic for teenagers. OBJECTIVE: To develop a validated food allergy QOL assessment tool for US adolescents (FAQL-teen). METHODS: Initial items were developed through expert opinion, literature review, and adolescent focus groups, resulting in an 88-question impact assessment questionnaire. This questionnaire was completed by 52 adolescents for effect scoring; final instrument questions were determined through analysis of effect scores. The final 17-item instrument was completed by 203 participants aged 13 to 19 years via an Internet link on the Food Allergy & Anaphylaxis Network Web site and via paper surveys distributed at a Food Allergy & Anaphylaxis Network conference. Items were scored on a 7-point Likert scale: 0 corresponded to "not troubled/limited," 3 to "moderately troubled/limited," and 6 to "extremely troubled/limited." RESULTS: Areas most troubling included limitations on social activities (score, 2.7), not being able to eat what others were eating (score, 2.7), and limited choice of restaurants (score, 3.9). Instrument validation steps showed strong internal validity (Cronbach α = .9). The instrument discriminated by disease severity: adolescents with a history of anaphylaxis had significantly lower QOL (higher scores) than did those without a history of anaphylaxis (P = .003). CONCLUSIONS: While developing a food allergy QOL assessment tool for US adolescents (FAQL-teen), we identified multiple social and emotional concerns that could be targeted for adolescent counseling. This instrument is internally valid and has the ability to discriminate, making it a useful tool in adolescent food allergy studies.

Audit of manufactured products: use of allergen advisory labels and identification of labeling ambiguities.

BACKGROUND: The Food Allergy Labeling and Consumer Protection Act became effective January 1, 2006, and mandates disclosure of the 8 major allergens in plain English and as a source of ingredients in the ingredient statement. It does not regulate advisory labels. OBJECTIVE: We sought to determine the frequency and language used in voluntary advisory labels among commercially available products and to identify labeling ambiguities affecting consumers with allergy. METHODS: Trained surveyors performed a supermarket survey of 20,241 unique manufactured food products (from an original assessment of 49,604 products) for use of advisory labels. A second detailed survey of 744 unique products evaluated additional labeling practices. RESULTS: Overall, 17% of 20,241 products surveyed contain advisory labels. Chocolate candy, cookies, and baking mixes were the 3 categories of 24 with the greatest frequency (> or = 40%). Categorically, advisory warnings included "may contain" (38%), "shared equipment" (33%), and "within plant" (29%). The subsurvey disclosed 25 different types of advisory terminology. Nonspecific terms, such as "natural flavors" and "spices," were found on 65% of products and were not linked to a specific ingredient for 83% of them. Additional ambiguities included unclear sources of soy (lecithin vs protein), nondisclosure of sources of gelatin and lecithin, and simultaneous disclosure of "contains" and "may contain" for the same allergen, among others. CONCLUSION: Numerous products have advisory labeling and ambiguities that present challenges to consumers with food allergy. Additional allergen labeling regulation could improve safety and quality of life for individuals with food allergy.